Effectiveness of seven non-pharmacological interventions to improve cognitive function in aged adults with cognitive decline: a Bayesian network meta-analysis_West China Medical Journal

Authors：

LIAO Changxiang ¹ , WANG Jing ² , LI Chunbiao ¹ , SUN Shuqin ¹ ,  YUAN Juan ¹ , HU Qianqian ¹

1. School of Nursing, Anhui University of Chinese Medicine, Hefei, Anhui 230031, P. R. China;
2. Department of Endocrinology, the First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, P. R. China;

Corresponding?author：

YUAN Juan, Email: 619296258@qq.com

Keywords：

Cognitive decline; the aged; non-pharmacological intervention; cognitive function; network meta-analysis

DOI：

10.7507/1002-0179.202401033

Video：

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Objective To evaluate the effect of different non-pharmacological interventions on the cognitive function of elderly people with cognitive decline, and provide useful reference for improving cognitive function of the elderly. Methods Computer searches of PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database, Wanfang Data, and China Biomedical Literature Database for randomized controlled trials on non-pharmacological interventions for aged adults with cognitive decline were conducted, all with a search time frame from database inception to October 9th, 2023. Literature screening, information extraction and bias risk assessment using RevMan 5.4 software were performed by two evaluators independently, and Stata 16.0 and R 4.3.0 software was used for network meta-analysis. Results A total of 27 articles involving 2149 elderly patients and 7 intervention protocols were included. Among the 27 articles, 8 were graded A and 19 were graded B for quality. The network meta-analysis revealed that, using the Montreal Cognitive Assessment (MoCA) as the evaluating metric, virtual reality [mean difference (MD)=6.01, 95% confidence interval (CI) (0.90, 10.75)], cognitive training [MD=4.99, 95%CI (0.56, 9.12)], and exercise training [MD=3.88, 95%CI (0.47, 7.27)] were better than community services, respectively (P<0.05), and exercise training was also better than conventional care [MD=3.05, 95%CI (0.92, 5.12), P<0.05]; using the Mini-Mental State Examination (MMSE) as the evaluation indicator, multimodal exercise [MD=3.00, 95%CI (0.89, 4.96)], cognitive training [MD=2.50, 95%CI (0.27, 4.82)], traditional Chinese exercise [MD=2.30, 95%CI (0.34, 4.28)], psychotherapy [MD=1.76, 95%CI (0.56, 2.96)], and exercise training [MD=1.36, 95%CI (0.18, 2.59)] were better than conventional care, respectively (P<0.05), and multimodal exercise [MD=3.32, 95%CI (0.62, 5.81)], cognitive training [MD=2.82, 95%CI (0.75, 4.90)], and traditional Chinese exercise [MD=2.63, 95%CI (0.08, 5.13)] were also better than community service, respectively (P<0.05). The results of the cumulative probability ranking showed that virtual reality had the highest probability of being the best intervention in terms of improving MoCA metrics (0.863), and multimodal exercise had the highest probability of being the best intervention in terms of improving MMSE metrics (0.868). Conclusion Using MoCA as an evaluation indicator, virtual reality may be the best non-pharmacological intervention; using MMSE as an evaluation indicator, multimodal exercise may be the best non-pharmacological intervention.

Citation： LIAO Changxiang, WANG Jing, LI Chunbiao, SUN Shuqin, YUAN Juan, HU Qianqian. Effectiveness of seven non-pharmacological interventions to improve cognitive function in aged adults with cognitive decline: a Bayesian network meta-analysis. West China Medical Journal, 2024, 39(5): 739-748. doi: 10.7507/1002-0179.202401033 Copy

1.	Jack CR, Bennett DA, Blennow K, et al. NIA-AA Research Framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement, 2018, 14(4): 535-562.
2.	韓理. 中國阿爾茨海默病臨床前期主觀認知下降的診治策略. 中國臨床醫學影像雜志, 2018, 29(8): 534-538.
3.	Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med, 2004, 256(3): 183-194.
4.	McGrattan AM, Pakpahan E, Siervo M, et al. Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: a systematic review and meta-analysis. Alzheimers Dement (N Y), 2022, 8(1): e12267.
5.	Rodakowski J, Saghafi E, Butters MA, et al. Non-pharmacological interventions for adults with mild cognitive impairment and early stage dementia: an updated scoping review. Mol Aspects Med, 2015, 43-44: 38-53.
6.	楊俊超, 王夢月, 邱俊強, 等. 5 類 14 種運動療法對輕度認知障礙病人總體認知功能影響的網狀 Meta 分析. 護理研究, 2023, 37(9): 1528-1537.
7.	孫凱麗. 社區輕度認知損害老人中醫護理干預研究. 武漢: 湖北中醫藥大學, 2018.
8.	Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-659.
9.	Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
10.	劉津池, 劉暢, 華成舸. 隨機對照試驗偏倚風險評價工具 RoB2(2019 修訂版)解讀. 中國循證醫學雜志, 2021, 21(6): 737-744.
11.	王瑩, 李梅, 董微, 等. 懷舊療法在糖尿病伴輕度認知功能障礙患者中的應用研究. 長春中醫藥大學學報, 2020, 36(3): 551-554.
12.	Savulich G, Piercy T, Fox C, et al. Cognitive training using a novel memory game on an iPad in patients with amnestic mild cognitive impairment (aMCI). Int J Neuropsychopharmacol, 2017, 20(8): 624-633.
13.	Pérez-Sáez E, Justo-Henriques SI, Alves Apóstolo JL. Multicenter randomized controlled trial of the effects of individual reminiscence therapy on cognition, depression and quality of life: analysis of a sample of older adults with Alzheimer’s disease and vascular dementia. Clin Neuropsychol, 2022, 36(7): 1975-1996.
14.	李晶. 人文關懷聯合游戲療法對老年輕度認知功能障礙住院患者主觀幸福感及生活質量的影響. 醫學臨床研究, 2019, 36(2): 403-405.
15.	Li L, Liu M, Zeng H, et al. Multi-component exercise training improves the physical and cognitive function of the elderly with mild cognitive impairment: a six-month randomized controlled trial. Ann Palliat Med, 2021, 10(8): 8919-8929.
16.	Choi W, Lee S. Ground kayak paddling exercise improves postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment: a randomized controlled trial. Med Sci Monit, 2018, 24: 3909-3915.
17.	Hagovská M, Olekszyová Z. Impact of the combination of cognitive and balance training on gait, fear and risk of falling and quality of life in seniors with mild cognitive impairment. Geriatr Gerontol Int, 2016, 16(9): 1043-1050.
18.	Doi T, Verghese J, Makizako H, et al. Effects of cognitive leisure activity on cognition in mild cognitive impairment: results of a randomized controlled trial. J Am Med Dir Assoc, 2017, 18(8): 686-691.
19.	Siu MY, Lee DTF. Effects of Tai Chi on cognition and instrumental activities of daily living in community dwelling older people with mild cognitive impairment. BMC Geriatr, 2018, 18(1): 37.
20.	Lazarou I, Parastatidis T, Tsolaki A, et al. International ballroom dancing against neurodegeneration: a randomized controlled trial in greek community-dwelling elders with mild cognitive impairment. Am J Alzheimers Dis Other Demen, 2017, 32(8): 489-499.
21.	Thapa N, Park HJ, Yang JG, et al. The effect of a virtual reality-based intervention program on cognition in older adults with mild cognitive impairment: a randomized control trial. J Clin Med, 2020, 9(5): 1283.
22.	Park JS, Jung YJ, Lee G. Virtual reality-based cognitive-motor rehabilitation in older adults with mild cognitive impairment: a randomized controlled study on motivation and cognitive function. Healthcare (Basel), 2020, 8(3): 335.
23.	Liao YY, Tseng HY, Lin YJ, et al. Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment. Eur J Phys Rehabil Med, 2020, 56(1): 47-57.
24.	Bisbe M, Fuente-Vidal A, López E, et al. Comparative cognitive effects of choreographed exercise and multimodal physical therapy in older adults with amnestic mild cognitive impairment: randomized clinical trial. J Alzheimers Dis, 2020, 73(2): 769-783.
25.	Hong SG, Kim JH, Jun TW. Effects of 12-week resistance exercise on electroencephalogram patterns and cognitive function in the elderly with mild cognitive impairment: a randomized controlled trial. Clin J Sport Med, 2018, 28(6): 500-508.
26.	Delbroek T, Vermeylen W, Spildooren J. The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial. J Phys Ther Sci, 2017, 29(7): 1137-1143.
27.	Lam LC, Chan WM, Kwok TC, et al. Effectiveness of Tai Chi in maintenance of cognitive and functional abilities in mild cognitive impairment: a randomised controlled trial. Hong Kong Med J, 2014, 20(3 Suppl 3): 20-23.
28.	Karthikeyan T. Therapeutic effects of home-based exercise of geriatrics for the management of cognitive impairment. ES J Public Health, 2020, 1(1): 1003.
29.	Varela S, Ayán C, Cancela JM, et al. Effects of two different intensities of aerobic exercise on elderly people with mild cognitive impairment: a randomized pilot study. Clin Rehabil, 2012, 26(5): 442-450.
30.	Bademli K, Lok N, Canbaz M, et al. Effects of physical activity program on cognitive function and sleep quality in elderly with mild cognitive impairment: a randomized controlled trial. Perspect Psychiatr Care, 2019, 55(3): 401-408.
31.	劉曉麗. 團體益智游戲對老年輕度認知功能障礙患者的影響. 河南醫學高等專科學校學報, 2022, 34(1): 79-82.
32.	吳含, 王彤, 徐蓉, 等. 有氧舞蹈對輕度認知障礙患者認知和運動功能的影響. 中國康復醫學雜志, 2019, 34(12): 1438-1443.
33.	張政. 基于蒙臺梭利理念下懷舊療法對 MCI 老年人認知功能的影響研究. 沈陽: 遼寧中醫藥大學, 2022.
34.	劉夢姣, 曾慧, 王曉松, 等. 多模式運動訓練對改善輕度認知功能障礙老年人軀體、認知功能的效果. 解放軍護理雜志, 2017, 34(9): 23-27.
35.	高明超, 牛煥敏, 姬少珍, 等. 健康促進與健康教育改善腦卒中輕度認知障礙的臨床觀察. 臨床醫藥實踐, 2020, 29(3): 166-169.
36.	孫景賢, 曾慧, 潘露. 認知訓練和穴位按摩對輕度認知功能障礙老年患者認知功能的影響研究. 中國全科醫學, 2016, 19(25): 3108-3111.
37.	辛慶鋒, 魏慧敏, 梁潘, 等. 社區綜合健康管理模式對非癡呆型血管性認知功能障礙患者認知功能的影響. 保健醫學研究與實踐, 2021, 18(1): 68-71.
38.	王濤, 郭志偉, 杜泳薈, 等. MoCA-B 與 MMSE 對輕度認知功能障礙患者的篩查效果對比. 西部醫學, 2021, 33(8): 1220-1224, 1229.
39.	Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry, 2007, 52(5): 329-332.
40.	甘露, 劉濤, 王淑華, 等. 中文版簡明精神狀態量表與蒙特利爾認知評估量表臨床應用進展. 中國康復醫學雜志, 2017, 32(7): 842-845.
41.	Yang HL, Chu H, Kao CC, et al. Development and effectiveness of virtual interactive working memory training for older people with mild cognitive impairment: a single-blind randomised controlled trial. Age Ageing, 2019, 48(4): 519-525.
42.	Zhong D, Chen L, Feng Y, et al. Effects of virtual reality cognitive training in individuals with mild cognitive impairment: a systematic review and meta-analysis. Int J Geriatr Psychiatry, 2021, 36(12): 1829-1847.
43.	Maeng S, Hong JP, Kim WH, et al. Effects of virtual reality-based cognitive training in the elderly with and without mild cognitive impairment. Psychiatry Investig, 2021, 18(7): 619-627.
44.	尹麗琴, 湯長發, 羅偉強, 等. 多模式運動對輕度認知功能障礙老年人認知功能、神經營養因子及全腦體積的影響. 中國體育科技, 2023, 59(3): 50-57.
45.	孫浩. 誘導性一氧化氮合酶參與阿爾茲海默病模型鼠病理進程. 南京: 南京醫科大學, 2010.
46.	倪品菲, 肇玉明. 蛋白質硝基化對神經退行性疾病的調控及藥物干預研究. 腦與神經疾病雜志, 2022, 30(3): 185-190.
47.	Gutiérrez-Camacho LR, Kormanovski A, Del Carmen Castillo-Hernández M, et al. Alterations in glutathione, nitric oxide and 3-nitrotyrosine levels following exercise and/or hyperbaric oxygen treatment in mice with diet-induced diabetes. Biomed Rep, 2020, 12(5): 222-232.

1. Jack CR, Bennett DA, Blennow K, et al. NIA-AA Research Framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement, 2018, 14(4): 535-562.
2. 韓理. 中國阿爾茨海默病臨床前期主觀認知下降的診治策略. 中國臨床醫學影像雜志, 2018, 29(8): 534-538.
3. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med, 2004, 256(3): 183-194.
4. McGrattan AM, Pakpahan E, Siervo M, et al. Risk of conversion from mild cognitive impairment to dementia in low- and middle-income countries: a systematic review and meta-analysis. Alzheimers Dement (N Y), 2022, 8(1): e12267.
5. Rodakowski J, Saghafi E, Butters MA, et al. Non-pharmacological interventions for adults with mild cognitive impairment and early stage dementia: an updated scoping review. Mol Aspects Med, 2015, 43-44: 38-53.
6. 楊俊超, 王夢月, 邱俊強, 等. 5 類 14 種運動療法對輕度認知障礙病人總體認知功能影響的網狀 Meta 分析. 護理研究, 2023, 37(9): 1528-1537.
7. 孫凱麗. 社區輕度認知損害老人中醫護理干預研究. 武漢: 湖北中醫藥大學, 2018.
8. Nasreddine ZS, Phillips NA, Bédirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc, 2005, 53(4): 695-659.
9. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res, 1975, 12(3): 189-198.
10. 劉津池, 劉暢, 華成舸. 隨機對照試驗偏倚風險評價工具 RoB2(2019 修訂版)解讀. 中國循證醫學雜志, 2021, 21(6): 737-744.
11. 王瑩, 李梅, 董微, 等. 懷舊療法在糖尿病伴輕度認知功能障礙患者中的應用研究. 長春中醫藥大學學報, 2020, 36(3): 551-554.
12. Savulich G, Piercy T, Fox C, et al. Cognitive training using a novel memory game on an iPad in patients with amnestic mild cognitive impairment (aMCI). Int J Neuropsychopharmacol, 2017, 20(8): 624-633.
13. Pérez-Sáez E, Justo-Henriques SI, Alves Apóstolo JL. Multicenter randomized controlled trial of the effects of individual reminiscence therapy on cognition, depression and quality of life: analysis of a sample of older adults with Alzheimer’s disease and vascular dementia. Clin Neuropsychol, 2022, 36(7): 1975-1996.
14. 李晶. 人文關懷聯合游戲療法對老年輕度認知功能障礙住院患者主觀幸福感及生活質量的影響. 醫學臨床研究, 2019, 36(2): 403-405.
15. Li L, Liu M, Zeng H, et al. Multi-component exercise training improves the physical and cognitive function of the elderly with mild cognitive impairment: a six-month randomized controlled trial. Ann Palliat Med, 2021, 10(8): 8919-8929.
16. Choi W, Lee S. Ground kayak paddling exercise improves postural balance, muscle performance, and cognitive function in older adults with mild cognitive impairment: a randomized controlled trial. Med Sci Monit, 2018, 24: 3909-3915.
17. Hagovská M, Olekszyová Z. Impact of the combination of cognitive and balance training on gait, fear and risk of falling and quality of life in seniors with mild cognitive impairment. Geriatr Gerontol Int, 2016, 16(9): 1043-1050.
18. Doi T, Verghese J, Makizako H, et al. Effects of cognitive leisure activity on cognition in mild cognitive impairment: results of a randomized controlled trial. J Am Med Dir Assoc, 2017, 18(8): 686-691.
19. Siu MY, Lee DTF. Effects of Tai Chi on cognition and instrumental activities of daily living in community dwelling older people with mild cognitive impairment. BMC Geriatr, 2018, 18(1): 37.
20. Lazarou I, Parastatidis T, Tsolaki A, et al. International ballroom dancing against neurodegeneration: a randomized controlled trial in greek community-dwelling elders with mild cognitive impairment. Am J Alzheimers Dis Other Demen, 2017, 32(8): 489-499.
21. Thapa N, Park HJ, Yang JG, et al. The effect of a virtual reality-based intervention program on cognition in older adults with mild cognitive impairment: a randomized control trial. J Clin Med, 2020, 9(5): 1283.
22. Park JS, Jung YJ, Lee G. Virtual reality-based cognitive-motor rehabilitation in older adults with mild cognitive impairment: a randomized controlled study on motivation and cognitive function. Healthcare (Basel), 2020, 8(3): 335.
23. Liao YY, Tseng HY, Lin YJ, et al. Using virtual reality-based training to improve cognitive function, instrumental activities of daily living and neural efficiency in older adults with mild cognitive impairment. Eur J Phys Rehabil Med, 2020, 56(1): 47-57.
24. Bisbe M, Fuente-Vidal A, López E, et al. Comparative cognitive effects of choreographed exercise and multimodal physical therapy in older adults with amnestic mild cognitive impairment: randomized clinical trial. J Alzheimers Dis, 2020, 73(2): 769-783.
25. Hong SG, Kim JH, Jun TW. Effects of 12-week resistance exercise on electroencephalogram patterns and cognitive function in the elderly with mild cognitive impairment: a randomized controlled trial. Clin J Sport Med, 2018, 28(6): 500-508.
26. Delbroek T, Vermeylen W, Spildooren J. The effect of cognitive-motor dual task training with the biorescue force platform on cognition, balance and dual task performance in institutionalized older adults: a randomized controlled trial. J Phys Ther Sci, 2017, 29(7): 1137-1143.
27. Lam LC, Chan WM, Kwok TC, et al. Effectiveness of Tai Chi in maintenance of cognitive and functional abilities in mild cognitive impairment: a randomised controlled trial. Hong Kong Med J, 2014, 20(3 Suppl 3): 20-23.
28. Karthikeyan T. Therapeutic effects of home-based exercise of geriatrics for the management of cognitive impairment. ES J Public Health, 2020, 1(1): 1003.
29. Varela S, Ayán C, Cancela JM, et al. Effects of two different intensities of aerobic exercise on elderly people with mild cognitive impairment: a randomized pilot study. Clin Rehabil, 2012, 26(5): 442-450.
30. Bademli K, Lok N, Canbaz M, et al. Effects of physical activity program on cognitive function and sleep quality in elderly with mild cognitive impairment: a randomized controlled trial. Perspect Psychiatr Care, 2019, 55(3): 401-408.
31. 劉曉麗. 團體益智游戲對老年輕度認知功能障礙患者的影響. 河南醫學高等專科學校學報, 2022, 34(1): 79-82.
32. 吳含, 王彤, 徐蓉, 等. 有氧舞蹈對輕度認知障礙患者認知和運動功能的影響. 中國康復醫學雜志, 2019, 34(12): 1438-1443.
33. 張政. 基于蒙臺梭利理念下懷舊療法對 MCI 老年人認知功能的影響研究. 沈陽: 遼寧中醫藥大學, 2022.
34. 劉夢姣, 曾慧, 王曉松, 等. 多模式運動訓練對改善輕度認知功能障礙老年人軀體、認知功能的效果. 解放軍護理雜志, 2017, 34(9): 23-27.
35. 高明超, 牛煥敏, 姬少珍, 等. 健康促進與健康教育改善腦卒中輕度認知障礙的臨床觀察. 臨床醫藥實踐, 2020, 29(3): 166-169.
36. 孫景賢, 曾慧, 潘露. 認知訓練和穴位按摩對輕度認知功能障礙老年患者認知功能的影響研究. 中國全科醫學, 2016, 19(25): 3108-3111.
37. 辛慶鋒, 魏慧敏, 梁潘, 等. 社區綜合健康管理模式對非癡呆型血管性認知功能障礙患者認知功能的影響. 保健醫學研究與實踐, 2021, 18(1): 68-71.
38. 王濤, 郭志偉, 杜泳薈, 等. MoCA-B 與 MMSE 對輕度認知功能障礙患者的篩查效果對比. 西部醫學, 2021, 33(8): 1220-1224, 1229.
39. Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: validity and utility in a memory clinic setting. Can J Psychiatry, 2007, 52(5): 329-332.
40. 甘露, 劉濤, 王淑華, 等. 中文版簡明精神狀態量表與蒙特利爾認知評估量表臨床應用進展. 中國康復醫學雜志, 2017, 32(7): 842-845.
41. Yang HL, Chu H, Kao CC, et al. Development and effectiveness of virtual interactive working memory training for older people with mild cognitive impairment: a single-blind randomised controlled trial. Age Ageing, 2019, 48(4): 519-525.
42. Zhong D, Chen L, Feng Y, et al. Effects of virtual reality cognitive training in individuals with mild cognitive impairment: a systematic review and meta-analysis. Int J Geriatr Psychiatry, 2021, 36(12): 1829-1847.
43. Maeng S, Hong JP, Kim WH, et al. Effects of virtual reality-based cognitive training in the elderly with and without mild cognitive impairment. Psychiatry Investig, 2021, 18(7): 619-627.
44. 尹麗琴, 湯長發, 羅偉強, 等. 多模式運動對輕度認知功能障礙老年人認知功能、神經營養因子及全腦體積的影響. 中國體育科技, 2023, 59(3): 50-57.
45. 孫浩. 誘導性一氧化氮合酶參與阿爾茲海默病模型鼠病理進程. 南京: 南京醫科大學, 2010.
46. 倪品菲, 肇玉明. 蛋白質硝基化對神經退行性疾病的調控及藥物干預研究. 腦與神經疾病雜志, 2022, 30(3): 185-190.
47. Gutiérrez-Camacho LR, Kormanovski A, Del Carmen Castillo-Hernández M, et al. Alterations in glutathione, nitric oxide and 3-nitrotyrosine levels following exercise and/or hyperbaric oxygen treatment in mice with diet-induced diabetes. Biomed Rep, 2020, 12(5): 222-232.

West China Medical Journal

Effectiveness of seven non-pharmacological interventions to improve cognitive function in aged adults with cognitive decline: a Bayesian network meta-analysis

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